The use of HFOV had no significant effect on 30-day mortality in patients undergoing mechanical ventilation for ARDS. (Funded by the National Institute for Health Research Health Technology Assessment Programme; OSCAR Current Controlled Trials number, ISRCTN10416500.).

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IntroductionHyperglycemia, hypoglycemia, and increased glycemic variability have each been independently associated with increased risk of mortality in critically ill patients. The role of diabetic status on modulating the relation of these three domains of glycemic control with mortality remains uncertain. The purpose of this investigation was to determine how diabetic status affects the relation of hyperglycemia, hypoglycemia, and increased glycemic variability with the risk of mortality in critically ill patients.MethodsThis is a retrospective analysis of prospectively collected data involving 44,964 patients admitted to 23 intensive care units (ICUs) from nine countries, between February 2001 and May 2012. We analyzed mean blood glucose concentration (BG), coefficient of variation (CV), and minimal BG and created multivariable models to analyze their independent association with mortality. Patients were stratified according to the diagnosis of diabetes.ResultsAmong patients without diabetes, mean BG bands between 80 and 140 mg/dl were independently associated with decreased risk of mortality, and mean BG bands >140 mg/dl, with increased risk of mortality. Among patients with diabetes, mean BG from 80 to 110 mg/dl was associated with increased risk of mortality and mean BG from 110 to 180 mg/dl with decreased risk of mortality. An effect of center was noted on the relation between mean BG and mortality. Hypoglycemia, defined as minimum BG <70 mg/dl, was independently associated with increased risk of mortality among patients with and without diabetes and increased glycemic variability, defined as CV >20%, was independently associated with increased risk of mortality only among patients without diabetes. Derangements of more than one domain of glycemic control had a cumulative association with mortality, especially for patients without diabetes.ConclusionsAlthough hyperglycemia, hypoglycemia, and increased glycemic variability is each independently associated with mortality in critically ill patients, diabetic status modulates these relations in clinically important ways. Our findings suggest that patients with diabetes may benefit from higher glucose target ranges than will those without diabetes. Additionally, hypoglycemia is independently associated with increased risk of mortality regardless of the patient's diabetic status, and increased glycemic variability is independently associated with increased risk of mortality among patients without diabetes.See related commentary by Krinsley, http://ccforum.com/content/17/2/131See related commentary by Finfer and Billot, http://ccforum.com/content/17/2/134

The proportion of patients who had postoperative stoma-related complications did not improve with time, but the rate of parastomal hernias in both groups and night-time emptying in the ileostomy group was worse with time. Ileostomy patients had a higher incidence of skin excoriation, leakage, soiling, and night-time emptying, and they should receive additional support.

One hundred and sixty-one consecutive patients with primary acute pancreatitis were admitted to a doubleblind trial of intravenous Trasylol therapy as a supplement to a standard regimen of conservative management. The patients were subdivided into younger (less than 60 years) and older patients (aged 60 years and over), and subjects in each group were randomly allocated on a double-blind basis either to Trasylol therapy (starter 500 000 KIU and thereafter 200 000 q.i.d. for 5 days) or to placebo. There were 14 deaths (8.7per cent), 7 in the Trasylol and 7 in the placebo group, and no significant difference was found in either the mortality or the major complications rate, eifher overall or within either age group.All I4 patients who died met the objective criteria for severe acute pancreatitis determined by the presence of at least three of a possible nine factors during the first 48 h of admission. Severe acute pancreatitis was present in 37 per cent of patients, who were evenly distributed between the Trasylol and placebo groups. Neither in those patients with severe nor those with less severe acute pancreatitis was there any sign%cant difference between the two therapeutic regimens. Supplementary intravenous Trasylol therapy at this dosage confers no advantage over standard conservative treatment in the management of patients with primary acute pancreatitis.